Peptic Ulcer Disease - Medications

Medications

Most peptic ulcers can be cured and prevented from returning by eliminating Helicobacter pylori (H. pylori) infections and avoiding use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Medications are used to:

• Treat peptic ulcer disease by reducing the amount of acid produced by the stomach.
• Kill H. pylori bacteria when it is determined that they are infecting the stomach lining.
• Prevent NSAID-related peptic ulcer disease by helping protect the lining of the stomach and upper small intestine (duodenum) from injury caused by NSAIDs.

Medication Choices

Medications to reduce acid production

Medications that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease.

• Histamine H₂ acid reducers (such as Tagamet, Zantac, Pepcid, and Axid) reduce the amount of acid produced by the stomach.
• Proton pump inhibitors (such as Prilosec, Prevacid, Aciphex, Protonix, and Nexium) also reduce the amount of acid produced by the stomach (and are more potent than histamine H₂ acid reducers).
• Antacids neutralize stomach acid.

Proton pump inhibitors may be taken with antibiotics if the ulcer is caused by an H. pylori infection.

Medications to kill H. pylori bacteria

Health professionals prescribe combination drug therapy to cure infection with H. pylori bacteria. Combination drug therapy usually includes at least two antibiotics, a proton pump inhibitor, and sometimes a bismuth compound.

Medications to prevent ulcers

Certain medications are used to protect the stomach from damage caused by frequent use of aspirin or other NSAIDs. These medications are called prostaglandin analogs (such as misoprostol). They are sometimes used to prevent NSAID ulcers.

What To Think About

Ulcers in the stomach (gastric ulcers) often heal more slowly than ulcers in the upper small intestine (duodenal ulcers).

Combination therapy that includes at least two antibiotics, an acid reducer (usually a proton pump inhibitor), and sometimes a bismuth compound is recommended for people who have peptic ulcer disease and are known to be infected with H. pylori. These combination regimens cure infections 80% to 90% of the time.^{4, 8} Successful treatment of the infection greatly reduces the chances that the ulcer will come back.

A nonprescription version of omeprazole (Prilosec OTC) has recently been approved by the U.S. Food and Drug Administration (FDA) for treatment of frequent heartburn. But omeprazole for treatment of more serious conditions, including peptic ulcers and gastroesophageal reflux disease (GERD), can only be prescribed by a doctor.